Non-white Youth Research Articles

Disparities in adequate mental health care for past-year major depressive episodes among white and non-white youth.

Following efforts made in recent years to have effective mental health treatments based on evidence-based guidelines, a working-definition of a minimum level of 'adequate mental health care (AMHC)' for serious mental illness (SMI) was developed in the literature. However, little is known about racial/ethnic disparities in receipt of adequate mental health care for SMI. The objective of this study was to examine disparities among Whites and non-Whites in receiving adequate mental health care for past-year major depressive episodes (MDE). The study sample was 1,688 US youth 12 to 17 years old affected by MDE in the 2005 National Survey on Drug Use and Health. We estimated the percentages of Whites and non-Whites that received adequate mental health care for MDE and estimated the correlates of receipt of adequate mental health care for the full sample and by racial/ethnic groups. About 34 percent of the sample received adequate mental health care; but separate analyses indicate that a significantly higher proportion of Whites (36 percent) received adequate mental health care relative to non-Whites (28 percent). The odds of receiving adequate mental health care for past-year MDE for Whites were 1.5 times that of non-Whites (p = 0.01). As more adolescents of diverse racial/ethnic backgrounds are identified to access mental health Treatment services, it might be important to examine the degree to which treatment should be tailored to engage and retain specific racial/ethnic groups to get the minimum of adequate mental health care.

Sustainable Spaces, Sustained Mass Incarceration: Environmental Protection as Racial Violence in the Design of Juvenile Incarceration

Though scholars of racial capitalism have separately analyzed mass incarceration and environmental racism as state-sanctioned racial violence, few have put these two seemingly disparate topics of study in direct conversation. Yet tracking “sustainability” in the designs of an environmentally friendly juvenile detention facility reveals that state-subsidized corporate mechanisms of environmental protection are fundamental to racialized mass incarceration in the United States. In the Alameda County Juvenile Justice Center in San Leandro, California, building designers constructed a juvenile court, social services center, and jail that all met the LEED (Leadership in Energy and Environmental Design) Gold Standard for sustainable construction practices put forth by the US Green Building Council. In this carceral space, however, the ideals of sustainable building design obfuscate the role of racial capitalism in sustaining the punitive regulation of Black and other nonwhite youth through incarceration.

Identification of Sexual Minority Youth in Pediatric Primary Care Settings Within a Large Integrated Healthcare System Using Electronic Health Records.

The aim of the study was to estimate the prevalence of sexual minority youth (SMY) within an integrated health care system using a standardized questionnaire. This study assessed SMY status in youth aged 12.5-18years using a previsit Well Check questionnaire at Kaiser Permanente Northern California facilities in 2016. SMY was defined as self-reported attraction to the same sex or both sexes. A total of 93,817 youth (87.3%) self-reported sexual attraction, and 5% (n= 5,329) of respondents (N = 107,532) identified as SMY: 1.7% were attracted to same sex, and 3.2% were attracted to both sexes. There were youth who responded neither (1.5%) and unsure (2.4%). Females were 2.8 times (95% confidence interval 2.6-2.94) more likely to be SMY than males. SMY status significantly increased with age. Nonwhite youth were significantly less likely to be SMY compared with white youth. This is the first study to examine SMY prevalence in pediatric primary care. Primary care providers can use previsit screening before preventive visits to identify and support sexual minority adolescents, facilitate family acceptance, and promote healthy behaviors with care coordination.

Meaning/fulness through Family: Discourses of Work among Poor and Working Class Youth

Rooted in neoliberal discourses, the current sociopolitical environment (including academia) delegitimizes work done by youth and people of color, positioning work as an individual accomplishment whose meaning/fulness lies in individual development or the work itself. Through interview research, I examine working class (largely nonwhite) youth’s articulation of the meaning/fulness of work as an opportunity to: 1) take responsibility for, 2) demonstrate reciprocity to, and 3) spend time with family members. Implications demonstrate work as relational process, suggest an extension of organizational citizenship behavior to a familial context, and challenge characterizations of the working class’ commitment to maintaining their socioeconomic status.

6.22 RACIAL AND ETHNIC VARIATIONS IN SEASONAL PATTERNS FOR YOUTH PSYCHIATRIC EMERGENCY DEPARTMENT VISITS

Recent research suggests important seasonal patterns in youth psychiatric emergency department (ED) use, including increased visits in the fall compared with those in the spring and summer. However, this research is limited by the use of statistical methods that do not account for well-documented racial and ethnic disparities in mental health service utilization. Nonwhite youth are significantly more likely to use psychiatric emergency services and less likely to use outpatient services than their white peers.

An Examination of Racial/Ethnic Disparities in Truancy Court

The purpose of this study was to examine the effect of race/ethnicity on recidivism outcomes with a sample of juveniles involved with a truancy court. Three regression models were conducted to examine the influence of race/ethnicity on receiving any new court petition ( N = 1,206), including petitions for delinquency offenses or any new status offense petition within 2 years of their initial contact with the court. Results suggest that racial/ethnic disparities exist for juveniles involved in truancy court, especially with regard to new delinquency petitions. These findings are important to take into consideration to understand how truancy courts may facilitate the school-to-prison pipeline for non-White youth.

Are There Gender, Racial, or Religious Denominational Differences in Religiosity’s Effect on Alcohol Use and Binge Drinking Among Youth in the United States? A Propensity Score Weighting Approach

Background: Alcohol use/misuse is a prevalent health issue among youth and may lead to adverse consequences. Religiosity has been identified as a protective factor against alcohol use/misuse among youth. Identifying moderators in the religiosity-alcohol relationship has important implications for intervention development. Objective: This study aims to examine whether gender, race, or religious denomination moderate the religiosity-alcohol relationship. Method: This study overcame previous studies’ limitations by using longitudinal data from a nationally representative sample and robust analytical methods (N = 1969). This study used the propensity score weighting method to control for a large number of confounders. Propensity score weights were estimated using Generalized Boosted Models. Results: Findings indicate that gender and religious denomination might not moderate the religiosity-alcohol relationship, whereas racial difference was present. Among White youth, religiosity was found to have a buffering effect against alcohol use (average treatment effect [ATE] = –0.57, CI.95 = –0.83, –0.32) and binge drinking (ATE = 0.54, CI.95 = 0.38, 0.71). However, among non-White youth, religiosity was not found to have an effect on alcohol use (ATE = 0.08, CI.95 = –0.31, 0.47) or binge drinking (ATE = 1.07, CI.95 = 0.68, 1.64). Conclusions: Findings suggest that preventions/interventions of youth alcohol involvement that are religiously based may not need to adapt their efforts based on youth’s gender or religious denominations. More importantly, when addressing alcohol use/misuse issue among White American youth, religious and faith-based organizations, youth religious group leaders, and clergy should be included in the prevention/intervention efforts.

Abstract P140: Sexual Orientation Disparities in Cardiovascular Risk Factors Differ by Sex and Race/Ethnicity Among High School Aged Youth

Compared to their sex-matched heterosexual counterparts, sexual minority high school aged youth have been found to be more likely to be overweight or obese and less likely to meet physical activity guidelines. Racial/ethnic minority (REM) youth have been shown to face similar disparities. These disparities mirror the cardiovascular (CVD) health disparities that have also been detected among sexual minority and REM adults later in life. To date, no national studies have investigated how health disparities associated with poor future CVD outcomes differ at the intersections of sex and race/ethnicity among diverse sexual minority high school aged youth. To compare weight and physical activity outcomes using an intersectional approach, we performed sex-stratified logistic regressions using a pooled national Youth Risk Behavior Surveillance (YRBS) dataset from 2009-2015; White heterosexual students as the dual reference group for all analyses. From these regressions, adjusted Prevalence risk ratios (PRR) were calculated. A total of 409,843 high school aged youth who completed the YRBS surveys across 45 jurisdictions across the United States were included in analyses. Overall, by race/ethnicity, 47.7% of respondents were White, 16.6% were Black, 25.5% were Hispanic/Latino, and 10.2% were “Other” race youth. Among male youth, 92.6% identified as heterosexual, 2.2% as gay, 2.4% as bisexual, and 2.7% as not sure, while among female students, 85.9% identified as heterosexual, 1.86% as lesbian, 8.25% as bisexual, and 4.0% as not sure. With the exception of heterosexual and not sure Other race students, all sexual minority/REM female students had 1.51 to 2.23 times higher risk of being overweight or obese compared to White heterosexual students. All non-White and non-heterosexual male youth were at greater risk of not meeting physical activity guidelines compared to their White heterosexual male student counterparts. Significant interactions between race/ethnicity and sexual identity were detected for both overweight/obesity and physical activity outcomes among female but not male high school aged youth. Future work should continue to characterize CVD risk factors among sexual minority and REM youth and explore how the intersections of these identities may predict risk factors for CVD related outcomes across the life course.

The Extent and Correlates of Stressors Experienced by At-risk Youths in a Military-style Residential Program

The aim of this study was to assess lifetime exposure to stressful life events among youths residing in a military-style program for at-risk adolescents. Both the types of stressors reported and the associations between youths’ exposure to stressors and problematic behaviors such as substance use and misconduct were examined. Exposure to stressful life events was assessed among 417 adolescents (87% male; 60% White; aged 16–19) using a self-report measure that allowed for the categorization of stressors into general types. Additional measures include self-reported substance use and program reports of youths’ disciplinary infractions. Descriptive data about the nature and number of stressful life events reported by the total sample and demographic subgroups is reported. Regression models including race and cumulative stressful life events revealed that White race and greater exposure to stressors were associated with more frequent alcohol, X2 (3) = 37.99, p < 0.001, and marijuana, X2 (3) = 21.24, p < 0.001 use, as well as indicators of substance use-related problems. A model using these same variables predicted count of disciplinary infractions, X2 (3) = 180.39, p < 0.001. When types of infractions were examined individually, several race by stress interactions indicate that non-White youths with high exposure to stressors are particularly likely to receive infractions. These findings provide descriptive information about stressors experienced by an understudied but at-risk population of youths. Additionally, they support the notion that history of exposure to stressful life events is related to externalizing behaviors during adolescence.

Disproportionate Experiences in Custody? An Examination of Minority Youths’ Outcomes in Secure Facilities

While a significant amount of literature has emphasized the identification and explanation of disproportionate minority contact (DMC) in the juvenile justice system, less research has examined racial disparities in postdisposition outcomes. This study seeks to address this gap through its examination of the experiences of youths in custody. Specifically, using a stratified, random subsample of 1514 youths confined in secure confinement facilities between 2010 and 2014 in one Midwestern state, this article explores whether youths’ race impacts in-facility outcomes, such as number of disciplinary infractions, time spent in seclusion, length of stay, and access to educational services, when case-level predictors are accounted for. Findings suggest that race has an inconsistent relationship with the outcomes experienced by youths in custody. However, significant mediating effects of disciplinary infractions on relationships between race and other outcomes appear to have significant implications for non-White youths in custody. Considering these findings, policy recommendations are discussed.

Examining the Relationship Between Race and Juvenile Court Decision-Making: A Counterfactual Approach

Prior research has found that disproportionate minority contact (DMC) is a problem at various decision-making points in the juvenile justice system. This study addresses two limitations often found in prior DMC research: (1) a focus on a single court and/or a single stage of the juvenile court process and (2) methodological problems in comparing youth of different races who are otherwise similarly situated. Nearest neighbor matching is used to examine the relationship between race and five juvenile court outcomes—pre-adjudication detention, case dismissal, adjudication, secure confinement, and waiver to criminal court—in a sample of over 50,000 youth referred to seven juvenile courts. After matching youth on multiple legal and extralegal variables, results indicate that non-White youth were significantly more likely than White youth to be detained prior to adjudication, placed in a secure confinement facility postadjudication, and waived to criminal court.

Reducing inequality summer by summer: Lessons from an evaluation of the Boston Summer Youth Employment Program

Many U.S. cities have implemented Summer Youth Employment Programs (SYEPs) with the hope of improving long-term behavioral, academic, and economic outcomes among program participants, particularly inner-city, low-income, and non-white youth. While recent empirical studies show positive impacts for some outcomes, little is known about program mechanisms and the potential to reduce inequality across groups. Using an embedded randomized control trial, this study evaluates improvements in short-term outcomes for the Boston SYEP based on survey data collected for both treatment and control groups during the summers of 2015, 2016, and 2017. Participants reported increases in community engagement and social skills, job readiness skills, and college aspirations that were significantly different from the control group. In most cases, the largest gains were observed for non-white youth suggesting that the program may have the capacity to reduce inequality across groups. Our hope is that this article will serve as a resource for those seeking to understand how summer jobs programs work and for whom, and to use these findings to strengthen and target the SYEP intervention. We also provide practical lessons learned regarding the development and deployment of our survey instrument to both the treatment and control groups among the youth population.

Association of Race and Ethnicity With Glycemic Control and Hemoglobin A1c Levels in Youth With Type 1 Diabetes

Health disparities in the clinical presentation and outcomes among youth with type 1 diabetes exist. Long-term glycemic control patterns in racially/ethnically diverse youth are not well described. To model common trajectories of hemoglobin A1c (HbA1c) among youth with type 1 diabetes and test how trajectory group membership varies by race/ethnicity. Longitudinal cohort study conducted in 5 US locations. The analysis included data from 1313 youths (aged <20 years) newly diagnosed in 2002 through 2005 with type 1 diabetes in the SEARCH for Diabetes in Youth study (mean [SD] age at diabetes onset, 8.9 [4.2] years) who had 3 or more HbA1c study measures during 6.1 to 13.3 years of follow-up. Data were analyzed in 2017. Self-reported race/ethnicity. Hemoglobin A1c trajectories identified through group-based trajectory modeling over a mean (SD) of 9.0 (1.4) years of diabetes duration. Multinomial models studied the association of race/ethnicity with HbA1c trajectory group membership, adjusting for demographic characteristics, clinical factors, and socioeconomic position. The final study sample of 1313 patients was 49.3% female (647 patients) with mean (SD) age 9.7 (4.3) years and mean (SD) disease duration of 9.2 (6.3) months at baseline. The racial/ethnic composition was 77.0% non-Hispanic white (1011 patients), 10.7% Hispanic (140 patients), 9.8% non-Hispanic black (128 patients), and 2.6% other race/ethnicity (34 patients). Three HbA1c trajectories were identified: group 1, low baseline and mild increases (50.7% [666 patients]); group 2, moderate baseline and moderate increases (41.7% [548 patients]); and group 3, moderate baseline and major increases (7.5% [99 patients]). Group 3 was composed of 47.5% nonwhite youths (47 patients). Non-Hispanic black youth had 7.98 higher unadjusted odds (95% CI, 4.42-14.38) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after full adjustment (adjusted odds ratio of non-Hispanic black race in group 3 vs group 1, 4.54; 95% CI, 2.08-9.89). Hispanic youth had 3.29 higher unadjusted odds (95% CI, 1.78-6.08) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after adjustment (adjusted odds ratio of Hispanic ethnicity in group 3 vs group 1, 2.24; 95% CI, 1.02-4.92). In stratified analyses, the adjusted odds of nonwhite membership in the highest HbA1c trajectory remained significant among male patients and youth diagnosed at age 9 years or younger, but not female patients and youth who were older than 9 years when they were diagnosed (P for interaction = .04 [sex] and .02 [age at diagnosis]). There are racial/ethnic differences in long-term glycemic control among youth with type 1 diabetes, particularly among nonwhite male patients and nonwhite youth diagnosed earlier in life.

Seen or Unseen? The Role of Race in Police Contact among Homeless Youth

Homeless youth are at an increased risk of police contact—being stopped by police and arrested, yet it is less clear if this interaction is patterned by race. The current study draws on diverse scholarship to examine three possible effects of race on homeless youths’ interaction with police: that non-White homeless youth are more likely (disproportionate minority contact/symbolic assailants), less likely (out-of-place policing) or no different than White youth (master status) to experience police contact. Using the Midwest Longitudinal Study of Homeless Adolescents, we examine homeless youths’ odds of self-reported police harassment and arrest. Non-White homeless youth are more likely to report police harassment and arrest, but living on the street neutralizes these racial disparities. Further, prior police harassment is linked to subsequent arrest, operating similarly for White and non-White homeless youth. We discuss the implications of these findings for advancing scholarship on the challenges faced by homeless youth.

Adolescent Racial Discrimination and Parental Perceptions of Safety in American Neighborhoods and Schools

Recently, a number of violent interracial interactions—between community members and public safety officers—has ignited a national debate about race, inequality, environmental/situational context, and the use of force among police and school resource officers. We investigate how perceptions of neighborhood and school safety are associated with adolescent exposure to racial discrimination. Using data from the National Survey of Child Health (NSCH) 2011–2012, we find that nonwhite youth experience greater levels of racial discrimination than their white counterparts after accounting for difference in exposure to violence and perceptions of neighborhood and school safety. Estimates from propensity score matching models show that differences in ever experiencing discrimination between safe and unsafe schools decline as perceptions of neighborhood safety increase, except in residential areas that are usually safe. Yet, black and Hispanic adolescents attending safe schools in neighborhoods that are always safe experience similar rates of discrimination as other nonwhite youth living in residential areas that are never safe. The implications for social mobility are discussed.

Nonwhite youth have more academic problems on alcohol and marijuana than white youth

Use of alcohol and/or marijuana during adolescence is associated with academic difficulties, use of other drugs in the future, poorer mental health, and a higher likelihood of abuse or dependence as adults. In addition, alcohol and drug use during the time when the brain is developing can result in deficits even after use has stopped.

Alcohol and marijuana use trajectories in a diverse longitudinal sample of adolescents: examining use patterns from age 11 to 17 years.

We tested race/ethnic differences in alcohol and marijuana (AM) trajectories (comprising an intercept term, reflecting overall probability of use, and a slope term, reflecting change in probability of use) during adolescence, whether AM use trajectories predicted high school outcomes, and whether outcomes differed by race/ethnicity after controlling for trajectory of AM use. This longitudinal study involved 6509 youth from 16 middle schools in Southern California surveyed from age 11.5 (2008) to age 17 (2015) years; all surveys assessed AM use, and the final survey also examined high school outcomes. Youth completed five surveys in middle school and two on-line surveys in high school. The sample was 50% male and 80% non-white. Intercept (at 2.75 years post-baseline) and slope of AM use were examined as outcomes for race/ethnic differences. AM use trajectories were examined as predictors of academic performance and unpreparedness, social functioning, mental and physical health and delinquency. We found differences in trajectories of use by race/ethnicity, with white youth reporting a higher overall intercept of alcohol use compared to all other groups (versus Asian P < 0.001, black P = 0.001, multi-ethnic P = 0.008). Overall, examination of trajectories of use showed that adolescents with a higher alcohol use intercept term reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001) at wave 7 in high school. In addition, youth with a higher intercept for marijuana use reported greater academic unpreparedness (P < 0.001) and delinquency (P < 0.001), and poorer academic performance (P = 0.032) and mental health (P = 0.002) in high school. At wave 7, compared to white youth, Hispanic and multi-ethnic youth reported poorer academic performance (P < 0.001 and P = 0.034, respectively); Asian, black and Hispanic youth reported higher academic unpreparedness (P < 0.001, P = 0.019, and P = 0.001); and Asian youth and multi-ethnic youth reported poorer physical health (P = 0.012 and P = 0.018) controlling for AM use. Greater AM use was associated with worse functioning in high school for all youth. After controlling for AM use, non-white youth reported worse outcomes in high school for academics and health.

A discrete-time analysis of the effects of more prolonged exposure to neighborhood poverty on the risk of smoking initiation by age 25

Evidence suggests that individuals who initiate smoking at younger ages are at increased risk for future tobacco dependence and continued use as well as for numerous smoking-attributable health problems. Identifying individual, household, and to a far lesser extent, contextual factors that predict early cigarette use has garnered considerable attention over the last several decades. However, the majority of scholarship in this area has been cross-sectional or conducted over relatively short windows of observation. Few studies have investigated the effects of more prolonged exposure to smoking-related risk factors, particularly neighborhood characteristics, from childhood through early adulthood. Using the 1970–2011 waves of the Panel Study of Income Dynamics merged with census data on respondents' neighborhoods, this study estimates a series of race-specific discrete-time marginal structural logit models for the risk of smoking initiation as a function of neighborhood poverty, as well as individual and household characteristics, from ages four through 25. Neighborhood selection bias is addressed using inverse-probability-of-treatment weights. Results indicate that more prolonged exposure to high (>20%) as opposed to low (<10%) poverty neighborhoods is associated with an increased risk of smoking onset by age 25, although consistent with prior literature, this effect is only evident among white and not nonwhite youth and young adults.

Can attachment and peer relation constructs predict anxiety in ethnic minority youths? A longitudinal exploratory study

ABSTRACTAnxiety is the most prevalent psychiatric disturbance in childhood effecting typically 15–20% of all youth. It has been associated with attachment insecurity and reduced competence in peer relations. Prior work has been limited by including mainly White samples, relying on questionnaires, and applying a cross-sectional design. The present study addressed these limitations by considering how at-risk non-White youth (n = 34) responded to the Friends and Family Interview (FFI) in middle childhood and how this linked up with anxiety symptoms and an anxiety diagnosis three years later in early adolescence. Five dimensions of secure attachment, namely, (i) to mother, (ii) to father, (iii) coherence, (iv) developmental understanding, and (v) social competence and quality of contact with best friend in middle childhood, were found to correlate significantly (and negatively) with self-reported anxiety symptoms. Linear regression results showed independent influences of female gender, and (low) quality of best friend contact as the most efficient model predicting anxiety symptoms. Logistic regression results suggested a model that included female gender, low social competence, and immature developmental understanding as efficient predictors of an anxiety diagnosis, evident in only 18% of the sample. These results point to the usefulness of after-school programs for at-risk minority youth in promoting peer competence, developmental awareness, and minimizing anxiety difficulties.

Costs of Development and Maintenance of an Internet Program for Teens with Type 1 Diabetes.

Many adolescents with type 1 diabetes (T1D) have difficulty completing self-management tasks within the context of their social environments. Group-based approaches to psycho-educational support have been shown to prevent declines in glucose control, but are challenging to implement due to youths' many activities and costs. A novel solution is providing psycho-educational support via the internet. The purpose of this study is to describe the cost of developing and maintaining two internet psycho-educational programs, both of which have been shown to improve health outcomes in adolescents with T1D. We calculated actual costs of personnel and programming in the development of TEENCOPE™ and Managing Diabetes, two highly interactive programs that were evaluated in a multi-site clinical trial (n=320). Cost calculations were set at U.S. dollars and converted to value for 2013 as expenses were incurred over 6 years. Development costs over 1.5 years totaled $324,609, with the majority of costs being for personnel to develop and write content in a creative and engaging format, to get feedback from teens on content and a prototype, and IT programming. Maintenance of the program, including IT support, a part-time moderator to assure safety of the discussion board (0.5-1 hour/week), and yearly update of content was $43,845/year, or $137.00 per youth over 4.5 years. Overall, program and site development were relatively expensive, but the program reach was high, including non-white youth from 4 geographically distinct regions. Once developed, maintenance was minimal. With greater dissemination, cost-per-youth would decrease markedly, beginning to offset the high development expense.